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HomeMy WebLinkAboutNCC215163_NOI Application_20210914Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 9/13/2021 10:43:31 AM (NCG01 NOI Submission) Approve by Broussard, Brooklyn C 9/13/2021 10:48:56 AM (Review- Construction NOI 64659) • The task was assigned to Broussard, Brooklyn C by round robin distribution 9/13/2021 10:44 AM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 15, 2021 5:00 PM 9/13/2021 10:44 AM Submit by Miller, Ariyelle L 9/14/2021 12:48:30 PM (Payment Verification for NCC215163) * Mary J Harrell • Miller, Ariyelle L assigned the task to Miller, Ariyelle L 9/14/2021 12:46 PM The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 25, 2021 5:00 PM 9/13/2021 10:49 AM .• SThF� '; 1 NORTH CAROLINA EnrlronmertW quallly A. Project Information Part A. Project Location and Waterbody Information Are you submitting IT No an NOI that was r Yes rejected before? 1a. Project Name * Duck Thru No. 59 1 b. Specific Lot This field nay be used to list specifc lot nunbers. Numbers 1 c. Parcel ID List all Rim associated w ith this project. Number(s) (PIN) 08760 2. County* Pitt 3. Highway or Street Bell Arthur Road Address* Street name only is acceptable if no address nunber assigned yet 4.CityorTownship* Greenville 5. State * NC 6. Zip Code* 27834 7. Latitude* Enter the latitude in decinal degrees 35.5602 8. Longitude * Enter the longitude in decinal degrees (MJSTbe negative) -77.4657 If you do not know the latitude and longitude coordinates for this project, you can search the location on this map of North Carolina. Look for the coordinates in the bottom left corner. 9. Date to Begin* 09/20/2021 Estinated Construction Project Start Late 10. Date to End * 09/16/2022 Estinated Construction Project End Date 11. SIC (Primary)* Commercial (1542) Standard Industrial aassification for Development 12. Acres to be 5.00 disturbed* (including off -site borrow and waste areas) 13. Total site area 4.76 (acres) * 14. Post- 1.82 construction (Estimated) impervious area (acres) * Project Tracking ID NCC-PITT-2021-Duck Thru No. 59 Assigned automatically (not used) Below you must enter waterbody information for surface waters affected by this project. Please consult DWR's Surface Water Classifications Map Viewer to find waterbody name and corresponding index number. Please enter only immediate receiving waterbodies - not waters downstream of those unless the project extends there. You may enter up to 3 waterbodies if needed. 15a. Receiving Little Contentnea Creek Waterbody* Name of waterbody into which stormwater runoff will discharge 15b. Waterbody 27-86-26 Index No. * NCWaterbody Index Number Stormwater V No discharges will flow r Yes to additional wate rs * 16a. Is this project r Yes subject to the NC r No, not subject to NC SPCA Sediment Pollution Control Act?* B. Permittee Information Part B. Fbrnittee Inforrration - Legally Fbsponsible Entity and Individual ......................................................................................................................................................... Important: The person who signs the NOI Certification Form and signs the Certification in Section E of this application form must be the same person as listed in THIS SECTION, or an authorized responsible individual within the same organization. That person must be a responsible corporate officer who owns or operates the construction activity, such as a president, secretary, treasurer, or vice president, or a manager that is authorized in accordance with Part IV, Section B, Item (6) of the NCG010000 General Permit. For more information on signatory requirements, see Part IV, Section B, Item (6) of that permit. 1. Permittee * Legally Pesponsible Entity Jernigan Oil Company, Inc. IF pernittee is an individual, enter first and last narre in this field. Otherwise, enter organization/business narre. Note: If the permittee is a business, the business must be registered with the NC Secretary of State. You can verify the registration here. 2. First Name * Michael If Corporation, enter Faegistered Agent First %rre 3. Last Name* Harrell IF Corporation, enter F;bgistered Agent Last %rre 3b. Title President 4. Permitee E-mail michaelh@jerniganoil.com Address* 5. Permittee 252-332-2131 Telephone No.* 6. Permittee Mailing Street Address Address* P. O. Box688 Address Line 2 City Ahoskie Fbstal / Zip Code 27910 Check box if the street address the same as mailing address 7. Permittee Street Address* F Yes Street Address 415 Main Street Address Line 2 city Ahoskie Fbstal / Zip Code 27910 State / Frovince / Fbgion NC Country us State / Frovince / Faegion NC Country us 8. Type of Ownership is only individual if an individual is naned in B.1. above. Ownership* Non -Government C. Site Contact Information Part C. ^ Roject Site Contact Inforrration ....................................................................................................................................................................................................................................................................................................................................................................................... 1. Primary Site Michael Contact - First Name * 2. Primary Site Harrell Contact - Last Name * 3. Title President 4. Site Contact E- michaelh@jerniganoil.com mail Address* 5. Site Contact 252-332-2131 Telephone No.* 6. Organization Jernigan Oil Company, Inc. Name 7. Site Contact Street Address Mailing Address* P.O. Box688 Address Line 2 City State / Rovince / Region Ahoskie NC Fbstal / Zip Code Country 27910 us 8. Consultant Name (Optional) Igor Palyvoda First and Last nacre 9. Consultant E-mail ipalyvoda@balduvindesignconsultants.com This person will be copied on all correspondence. 10. Consultant 252-756-1390 Telephone No. 11. Billing E-mail (For Annual Fee correspondence) michaelh@jerniganoil.com Default is legally responsible person e-rrail 12. Billing (For Annual Fee correspondence) Telephone 252-332-2131 Default is legally responsible person telephone D. E&SC Plan Part D. ^ Erosion & Sediment Control (E&SC) Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 07/28/2021 Approved * 2. E&SC Plan Project PC SESC 2021-09 Number/ID * Assigned by agency or local program 3. E&SC Plan f State DEQ Office Approved by* r Local Program 4. Local Program* Pitt County Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a complete application. Please also upload a site map showing the overall extent of the project (for linear projects, can include the beginning point and end point coordinates in the "Notes" box below). 5. E&SC Plan 20-141 - Duck Thru No. 59 - EC Approval.pdf 99.28KB Approval letter or Mast beRDFforml Grading Permit 6. Signed FRO Financial Pesponsibility/Ojvnership Form 20-141 - Duck Thru No. 59 - Signed FRO.pdf 82.03KB Mast be RDFfornat 7. Site Location Map Mast be RDFforrrat (lirrit 20 NB) 20-141 - Duck Thru No. 59 - Vicinity Map.pdf 48.94KB Rease do not upload entire set of E&SC plans. 8. Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded documents support the application. Include additional w aterbodies if necessary. 9. NOI Certification 20-141 - Duck Thru No. 59 - Signed NOI.pdf 78.92KB Form Mast be R7Ffon-rat This is an Express F No Review Project* r Yes E. Certification North Carolina General Statute 143-215.66 (1) provides that: Any person who knowingly makes anyfalse statement, representation, or certification in any application, record, report, plan, or other document filed or required to be maintained under this Article or a rule implementing this Atide; or who knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case under this Atcle; or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Amide or rules of the Commission implementing this Atcle shall be guilty ofa Class 2 misdemeanor which may include a fine not to exceed ten thousand dollars ($10,000). Under penalty of law, I certify that: 17 I am the person responsible for the construction activities of this project, for satisfying the requirements of this permit, and for any civil or criminal penalties incurred due to violations of this permit. rJ The information submitted in this NOI is, to the best of my knowledge and belief, true, accurate, and complete based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information. * 17 I will abide by all conditions of the NCG010000 General Permit and the approved Erosion and Sediment Control Plan. * rJ If the Erosion and Sediment Control Plan approved by the delegated program is not compliant with Part II (Stormwater Pollution Prevention Plan) of the NCG010000 General Permit. I will nonetheless ensure that all conditions of Part II of the permit are met on the project at all times. * 17 I hereby request coverage under the NCG010000 General Permit and understand that coverage under this permit will constitute the permit requirements for the discharge(s) and is enforceable in the same manner as an individual permit. Specify if you are:* r The Legally Responsible Person named on this Notice of Intent f Authorized Responsible Person' (signing on behalf of Legally Responsible Person named in Part B) Important: The person who electronically signs this Certification above must be the same person who signs the NOI Certification Form. If that person is signing on behalf of the Permittee, that individual must be an authorized responsible person within the same organization as the Permittee. *An authorized individual is a responsible corporate officer who owns or operates the construction activity, such as a president, secretary, treasurer, or vice president, or a manager that is authorized in accordance with Part IV, Section B, Item (6) of the NCG010000 General Permit. For more information on signatory requirements, see Part IV, Section B, Item (6) of that permit. Signature Type Name* J. Michael Harrell Title President Organization Legally Ibsponsible Entity Jernigan Oil Company, Inc. Date * 09/13/2021 F. Tracking and COC Info NOI Tracking No. 64659 NC Reference No. NCG01-2021-5163 Uses 'count_nurrber' variable (increrrented by SP) Certificate of NCC215163 Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP) No.* Count Number 5163 Sequential nurrber for subrrittal that is incremented by Stored Frocedure COC Year 2021 Year of date reviewed (used to assign YY digits after "NOC' in COCno.) Initial Invoice No. NCC215163-2021 Invoice Due Date 10/13/2021 Initial Fee $ 100.00 Invoice Status OPEN